Beyond Protein Restriction: Comparative eADI-17-Estimated Anti-Inflammatory Profiles of Four Renal Diets

Chronic low-grade inflammation contributes to chronic kidney disease (CKD) progression and cardiovascular complications. Although nutritional therapy is central to CKD management, the estimated anti-inflammatory profiles of renal diets remain poorly characterized.

We analyzed 40 daily menus with broadly comparable, although not identical, energy content (10 per dietary pattern): Mediterranean renal diet (MedRen; 0.8 g protein/kg), vegan diet (0.7 g/kg), conventional low-protein diet (LPD; 0.6 g/kg), and supplemented very-low-protein diet (sVLPD; 0.3 g/kg). Dietary anti-inflammatory potential was estimated using the 17-component empirical Anti-inflammatory Diet Index (eADI-17), with higher scores indicating a more favorable profile. Groups were compared using exploratory non-parametric tests with multiple-comparison correction; nutrient associations were assessed using Spearman correlations with false-discovery-rate correction.

Mean eADI-17 scores were 11.90 ± 0.66 for MedRen, 9.75 ± 0.63 for vegan, 8.90 ± 1.10 for LPD, and 8.40 ± 0.52 for sVLPD. MedRen scored higher than all other diets, and vegan scored higher than sVLPD. In pooled analyses, eADI-17 correlated positively with total protein and phosphorus and negatively with vitamin C and total carbohydrate; none of these associations remained significant after accounting for dietary-group membership.

The eADI-17-estimated anti-inflammatory potential of renal diets depends on the overall dietary pattern and does not necessarily improve with greater protein restriction. Because eADI-17 is an indirect food-based index and inflammatory biomarkers were not measured, these findings are hypothesis-generating and require validation in studies of actual intake, biomarkers, and clinical outcomes.